Top Hmo Trying To Avert State Takeover

April 16, 1986|By Ken Cummins, Washington Bureau

WASHINGTON — Florida`s largest health maintenance organization says it is willing to spend $9.1 million to head off possible action by state officials to declare the company insolvent and take it over.

Meanwhile, five federal agencies are investigating International Medical Centers in the wake of allegations of possible criminal wrongdoing forwarded to the FBI by Rep. Dan Mica two weeks ago, the congressman revealed Wednesday.

Mica, D-Lake Worth, said a House health subcommittee also may begin its own probe into IMC.

Besides the infusion of more cash into the HMO, state officials have asked IMC to take other corrective action, including reducing its huge backlog of unpaid bills and canceling its planned expansion into Sarasota and Manatee counties, according to information provided to Mica by an IMC official.

But a spokesman for Florida Insurance Commissioner Bill Gunter said IMC may have to come up with still more money or take other actions to correct its financial problems in order to avoid a possible take over by the Florida Department of Insurance. The department has regulatory powers over HMOs.

``There`s no one thing that will solve this problem,`` department spokesman David Voss said.

Juan del Real, chief counsel for IMC, said he was not aware of any federal investigations into possible criminal wrongdoing by his company.

``I am aware that the Health Care Financing Administration is conducting a compliance review as it frequently does,`` del Real said. ``I am also aware that the insurance commission is conducting its regular review.

``I have not been notified of any other investigations, nor has the company.``

Auditors from HCFA have been at IMC`s offices in Miami since the beginning of last week going over the HMO`s financial records. The state audit of IMC`s most recent financial statements is expected to be completed by Friday, Voss said.

The IMC attorney said the $9.1 million infusion of new cash ``is what the insurance commissioner has required of us.`` But del Real was unable to say late Wednesday where IMC hopes to obtain the money requested by state officials.

The department of insurance has told IMC it must come up with the cash without taking out new loans or otherwise adding to its current debt, Voss and del Real said.

IMC is the nation`s largest HMO for Medicare recipients and receives $30 million monthly from the federal government for Medicare recipients enrolled in the HMO. IMC currently has nearly 200,000 subscribers in South Florida and also operates its Gold Plus plans in the St. Petersburg-Tampa area.

But Mica said he has received nearly 2,000 complaints about IMC`s operations over the past fseveral months, including complaints from doctors who charge that bills submitted to IMC have gone unpaid for more than a year, despite the huge monthly payments from the federal government.

IMC officials have blamed the unpaid bills on a computer malfunction they said destroyed 5,000 of the claims for payments submitted to IMC.

Voss said the HMO is able to pay its bills on a day-to-day basis but may still be declared insolvent by state insurance officials if they determine that IMC`s debts far outweigh its assets.

Mica said del Real contacted Mica and provided him with details of the agreement IMC officials claim has been worked out through lengthy negotiations with state insurance officials to forestall a takeover by the state.

But Voss insisted, ``We have made no promises to IMC.``

Mica also said del Real refuted allegations that some of IMC`s money and assets have been taken out of the country. The congressman said he was told that this money had been transferred to Recarey Enterprises Insurance Limited, a liability insurance company in the Grand Cayman Islands owned by Miguel Recarey Jr., president of IMC.

IMC attorney del Real said this company had been set up offshore so that IMC could obtain medical malpractice insurance outside the United States. He said the HMO had been unable to obtain liaibility coverage from U. S. firms.

``This is not anything having to do with siphoning funds out of the country,`` del Real said. ``This is a legitimate business practice.``

Mica said after the meeting in Bowen`s office that the FBI is coordinating criminal and civil inquiries into allegations against IMC currently being pursued by the bureau and by the U.S. Department of Labor, the Inspector General of the Department of Health and Human Services, the General Accounting Office and HCFA.